Pharmacology: Drugs Affecting Blood Pressure

Essential (primary) hypertension

High blood pressure with no identifiable cause, often due to genetics.

Secondary hypertension

High blood pressure caused by an underlying medical condition.

Orthostatic hypotension

A sudden drop in blood pressure when sitting up or standing.

ACE Inhibitors suffix

-pril

ACE Inhibitors (Mechanism of Action)

Prevents conversion of angiotensin I to angiotensin II in the lungs.

ACE Inhibitors (Electrolyte effect)

Increases potassium levels while causing loss of sodium and fluid.

ACE Inhibitors (Black Box Warning)

Can cause serious injury or death to a developing fetus.

ACE Inhibitors (Adverse effects)

Hyperkalemia, dry cough, hypotension, renal impairment, and angioedema.

ACE Inhibitors (Administration timing)

Take on an empty stomach, 1 hour before or 2 hours after meals.

ARBs suffix

-sartan

ARBs (Mechanism of Action)

Blocks vasoconstriction and aldosterone-secreting effects of angiotensin II.

Calcium Channel Blockers (Mechanism of Action)

Inhibits calcium influx across cardiac and smooth muscle to cause vasodilation.

Calcium Channel Blockers (Food interaction)

Grapefruit and grapefruit juice must be avoided.

Calcium Channel Blockers (Adverse effects)

Hypotension, arrhythmias, pulmonary edema, and peripheral edema.

Alpha-Adrenergic Blockers (Mechanism of Action)

Dilates blood vessels and decreases peripheral vascular resistance.

First-dose phenomenon

Severe hypotension/syncope after the initial dose of alpha-blockers.

Alpha-Adrenergic Blockers (Administration timing)

Take the first or increased dose at bedtime to prevent syncope.

Beta-Adrenergic Blockers (Hypoglycemia risk)

Can mask the typical signs and symptoms of hypoglycemia.

Vasodilators (Mechanism of Action)

Directly relaxes smooth muscle in blood vessels to cause dilation.

Nitroprusside (Specific toxicity)

Can lead to life-threatening cyanide toxicity.

Nitroglycerin (Drug interaction)

Never take with erectile dysfunction medications due to severe hypotension risk.

Nitroglycerin patch (Administration schedule)

Remove the patch at night and reapply a new one in the morning.

Thiazide Diuretics (Mechanism of Action)

Decreases reabsorption of sodium, water, chloride, and bicarbonate.

Loop Diuretics (Mechanism of Action)

Inhibits sodium and chloride reabsorption in the loop of Henle.

Loop Diuretics (Major adverse effect)

Rapid depletion of potassium (hypokalemia).

Loop Diuretics (Sensory adverse effect)

Ototoxicity (hearing impairment), especially at high doses.

Potassium-Sparing Diuretics (Mechanism of Action)

Blocks sodium-retaining effects of aldosterone, keeping potassium in the body.

Spironolactone (Specific adverse effects)

Gynecomastia, deepening of voice, testicular atrophy, and menstrual irregularities.

The three high-alert medications

Insulin, anticoagulants, and opioids

Fastest route of medication administration

Intravenous (IV)

If an order looks unsafe or incomplete, the nurse should

Clarify/verify it before administration

Sympathetic nervous system

Fight or flight

Parasympathetic nervous system

Rest and digest

Sympathetic neurotransmitters

Epinephrine and norepinephrine

Parasympathetic neurotransmitter

Acetylcholine

Alpha receptors generally cause

Constriction

Beta receptors generally cause

Relaxation

β₁ receptors primarily affect

The heart

β₂ receptors primarily cause

Bronchodilation

Agonist

A drug that mimics or stimulates a receptor/system

Antagonist

A drug that blocks a receptor/system

Two cholinergic receptor types

Muscarinic and nicotinic

Adrenergic agonists are also called

Sympathomimetics

Adrenergic antagonists are also called

Sympatholytics (adrenergic blockers)

SLUDGE stands for

Salivation, Lacrimation, Urination, Diarrhea, GI upset, Emesis

Common anticholinergic effects

Dry mouth, blurred vision, urinary retention

Rescue inhaler for an acute asthma attack

Albuterol

Controller inhalers should be taken

Regularly/daily

Why rinse your mouth after an inhaled corticosteroid (ICS)?

To prevent thrush

Drug that reverses opioid overdose

Naloxone (Narcan)

Combining opioids, benzodiazepines, and alcohol increases risk of

Respiratory depression

Most CNS medications should not be stopped abruptly because

They must be tapered

Loop diuretics affect potassium by

Decreasing/losing potassium

Potassium-sparing diuretics affect potassium by

Retaining/conserving potassium

Anticoagulants and antiplatelet drugs increase the risk of

Bleeding

Beta 1 mnemonic

1 heart

Beta 2 mnemonic

2 lungs

LOL drugs

Beta blockers

Examples of LOL drugs

Metoprolol, propranolol

SARTAN drugs

ARBs

Examples of SARTAN drugs

Losartan, valsartan

PRIL drugs

PPIs

Common exception to the PRIL pattern

Omeprazole

STATIN drugs

Cholesterol medications

PAM drugs

Benzodiazepines

Examples of PAM drugs

Diazepam, lorazepam

What receptor does acetylcholine act on?

Muscarinic and nicotinic receptors

What neurotransmitters activate the sympathetic nervous system?

Epinephrine and norepinephrine

Which receptor causes bronchodilation?

β₂ receptor

Which receptor increases heart rate and contractility?

β₁ receptor

What is the major concern with anticoagulants?

Bleeding

What is the major concern with opioids?

Respiratory depression

What electrolyte is commonly lost with loop diuretics?

Potassium

What is a common adverse effect of inhaled corticosteroids?

Oral thrush

What is the antidote for opioid overdose?

Naloxone (Narcan)

What does a sympathomimetic drug do?

Mimics the sympathetic nervous system

What does a sympatholytic drug do?

Blocks the sympathetic nervous system

ACE inhibitor drug ending

-pril

Examples of ACE inhibitors

Lisinopril, enalapril, captopril

ACE inhibitors mechanism of action

Block conversion of angiotensin I to angiotensin II

ACE inhibitors lower blood pressure by

Vasodilation and decreased aldosterone

Common ACE inhibitor side effect

Dry cough

Serious ACE inhibitor side effect

Angioedema

ACE inhibitors can increase

Potassium

ARB drug ending

-sartan

Examples of ARBs

Losartan, valsartan

ARBs mechanism of action

Block angiotensin II receptors

Why are ARBs often used instead of ACE inhibitors?

They do not usually cause a cough

ARBs can increase

Potassium

Beta blocker drug ending

-lol

Examples of beta blockers

Metoprolol, propranolol, carvedilol

Beta blockers primarily affect which receptor?

β₁ receptors

Effects of beta blockers

Decreased heart rate and blood pressure

Before giving a beta blocker, assess

Heart rate and blood pressure

Major adverse effect of beta blockers

Bradycardia

Calcium channel blocker examples

Amlodipine, diltiazem, verapamil, nifedipine

Calcium channel blockers cause

Vasodilation

Common side effect of calcium channel blockers

Hypotension

Common side effect of amlodipine

Peripheral edema

Loop diuretic prototype

Furosemide (Lasix)